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Surfactant in the preterm infant: what's going on

Carlo Dani1, Jacopo Barp, Elettra Berti

  • 1Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Florence, Italy. cdani@unifi.it

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|November 21, 2009
PubMed

Insights

Surfactant therapy reduces lung problems and death in premature infants. Natural surfactants and early treatment are most effective, with ongoing research into improved surfactant strategies for respiratory distress syndrome.

Area of Science:

  • Neonatal Medicine
  • Pulmonology
  • Biochemistry

Background:

  • Surfactant administration is a cornerstone in managing respiratory distress syndrome (RDS) in preterm infants.
  • Established benefits include reduced pneumothorax and mortality.
  • Current clinical practice is evolving due to widespread antenatal steroid use and nasal continuous positive airway pressure (nCPAP).

Purpose of the Study:

  • To review the current evidence on surfactant treatment strategies for preterm infants.
  • To discuss the evolving role of surfactant prophylaxis versus rescue therapy.
  • To explore future directions for enhancing surfactant therapy, particularly for preventing bronchopulmonary dysplasia (BPD).

Main Methods:

  • Review of existing literature on surfactant therapy in neonatal respiratory distress.
  • Analysis of clinical trial data comparing different surfactant types and treatment timings.
  • Examination of the impact of antenatal steroids and nCPAP on RDS management.

Main Results:

  • Natural surfactants demonstrate superior efficacy compared to synthetic alternatives.
  • Early surfactant rescue treatment is more beneficial than delayed treatment.
  • The indications for surfactant prophylaxis are being re-evaluated in light of modern RDS management.

Conclusions:

  • Surfactant therapy remains critical for preterm infants with RDS, with a preference for natural surfactants and early intervention.
  • The changing clinical landscape necessitates a re-evaluation of optimal surfactant strategies.
  • Future research may focus on augmenting exogenous natural surfactants with anti-inflammatory and antioxidant agents to combat lung injury and prevent BPD.

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